The Impact of OCT on Diagnostic Accuracy of the Technology-Based Eye Care Services Protocol

Maa, April Y.; McCord, Sarah; Lu, Xiaoqin Alexa; Janjua, Rabeea; Howell, Ashley V.; Hunt, Kelly J.; Medert, Charles M.; Giangiacomo, Annette; Lynch, Mary G.

doi:10.1016/j.ophtha.2019.10.025

Cited by 14 publications

(26 citation statements)

References 13 publications

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“…17 Only one study in this systematic review provided a direct comparison in the diagnostic accuracy of fundus photography combined with OCT and fundus photography alone. 17 In the paper by Maa et al, despite the detailed cross-sectional analysis of the macula, optic nerve head and retinal nerve fibre layer that is provided in OCT scans, the authors did not detect any improvement in sensitivity or specificity of fundus photography for the detection of glaucoma and retinal disorders with the addition of OCT. 17 In contrast to these results, other groups have clearly demonstrated a role for OCT in addition to fundus photographs, especially for the detection of diabetic macula oedema which requires a stereoscopic view. [31][32][33][34][35] In the current metaanalysis, only a fraction of the studies used OCT alone or as an adjunct modality in addition to fundus photographs and we were unable to perform a formal meta-regression.…”

Section: Discussionmentioning

confidence: 99%

“…Here, we presented our findings from a systematic review and meta-analysis on estimates of sensitivity and specificity of teleretinal screening for detection of DR and AMD when compared with face-to-face clinical examination as the real-world reference standard. 17 18 We found that teleretinal screening achieved a high accuracy for detection of any DR with a sensitivity of 0.91 (95% CI: 0.82 to 0.96) and specificity of 0.88 (95% CI: 0.74 to 0.95) and referrable DR with a sensitivity of 0.88 (95% CI: 0.81 to 0.93) and specificity of 0.86 (95% CI: 0.79 to 0.90).…”

Section: Discussionmentioning

confidence: 99%

“… 9 Lastly, face-to-face examination is a reputable consistent reference standard for all of the diagnoses included in the review including AMD, whereas the evidence supporting the ETDRS protocol stems from DR literature. 17 19 20 …”

Section: Methodsmentioning

confidence: 99%

“…The selection of this reference standard was based on three important justifications. First, face-toface clinical examination is an established real-world modality for diagnosis and monitoring of patients with DR. [16][17][18] Second, in-person examination is in keeping with the clinical pathway of most teleretinal screening programmes where selected patients with high-risk features or ungradable patients are ultimately referred for office-based examination. 9 Lastly, face-to-face examination is a reputable consistent reference standard for all of the diagnoses included in the review including AMD, whereas the evidence supporting the ETDRS protocol stems from DR literature.…”

Section: Reference Standardmentioning

confidence: 99%

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Diagnostic accuracy of teleretinal screening for detection of diabetic retinopathy and age-related macular degeneration: a systematic review and meta-analysis

et al. 2022

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ObjectiveTo evaluate the diagnostic accuracy of teleretinal screening compared with face-to-face examination for detection of diabetic retinopathy (DR) and age-related macular degeneration (AMD).Methods and analysisThis study adhered to the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA). A comprehensive search of OVID MEDLINE, EMBASE and Cochrane CENTRAL was performed from January 2010 to July 2021. QUADAS-2 tool was used to assess methodological quality and applicability of the studies. A bivariate random effects model was used to perform the meta-analysis. Referrable DR was defined as any disease severity equal to or worse than moderate non-proliferative DR or diabetic macular oedema (DMO).Results28 articles were included. Teleretinal screening achieved a sensitivity of 0.91 (95% CI: 0.82 to 0.96) and specificity of 0.88 (0.74 to 0.95) for any DR (13 studies, n=7207, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) low). Accuracy for referrable DR (10 studies, n=6373, GRADE moderate) was lower with a sensitivity of 0.88 (0.81 to 0.93) and specificity of 0.86 (0.79 to 0.90). After exclusion of ungradable images, the specificity for referrable DR increased to 0.95 (0.90 to 0.98), while the sensitivity remained nearly unchanged at 0.85 (0.76 to 0.91). Teleretinal screening achieved a sensitivity of 0.71 (0.49 to 0.86) and specificity of 0.88 (0.85 to 0.90) for detection of AMD (three studies, n=697, GRADE low).ConclusionTeleretinal screening is highly accurate for detecting any DR and DR warranting referral. Data for AMD screening is promising but warrants further investigation.PROSPERO registration numberCRD42020191994.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Reference Standardmentioning

confidence: 99%

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Diagnostic accuracy of teleretinal screening for detection of diabetic retinopathy and age-related macular degeneration: a systematic review and meta-analysis

et al. 2022

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“…Since optical coherence tomography (OCT) was first described in 1991, 1 it has revolutionized the clinical management of various retinal pathologies, and its application continues to accelerate at a tremendous pace. 2 OCT can generate three-dimensional (3D) models of the retina at a submicrometer resolution and has become the standard of care for evaluating many ophthalmic disorders, 3 such as age-related macular degeneration (AMD) 4 , 5 and diabetic macular edema (DME). 6 , 7 Although the diagnosis of primary open-angle glaucoma (POAG) has been based on the assessment of structural and functional damage identified through the use of fundus photography and visual fields, respectively, there is an increasing use of macular OCT thickness evaluation as a reliable metric for glaucoma disease detection and longitudinal management.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Clinical Utility of Expanded Macular OCTs Using Machine Learning

Lin

Lee

Blazes

et al. 2021

Trans. Vis. Sci. Tech.

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Purpose Optical coherence tomography (OCT) is widely used in the management of retinal pathologies, including age-related macular degeneration (AMD), diabetic macular edema (DME), and primary open-angle glaucoma (POAG). We used machine learning techniques to understand diagnostic performance gains from expanding macular OCT B-scans compared with foveal-only OCT B-scans for these conditions. Methods Electronic medical records were extracted to obtain 61 B-scans per eye from patients with AMD, diabetic retinopathy, or POAG. We constructed deep neural networks and random forest ensembles and generated area under the receiver operating characteristic (AUROC) and area under the precision recall (AUPR) curves. Results After extracting 630,000 OCT images, we achieved improved AUROC and AUPR curves when comparing the central image (one B-scan) to all images (61 B-scans). The AUROC and AUPR points of diminishing return for diagnostic accuracy for macular OCT coverage were found to be within 2.75 to 4.00 mm (14–19 B-scans), 4.25 to 4.50 mm (20–21 B-scans), and 4.50 to 6.25 mm (21–28 B-scans) for AMD, DME, and POAG, respectively. All models with >0.25 mm of coverage had statistically significantly improved AUROC/AUPR curves for all diseases ( P < 0.05). Conclusions Systematically expanded macular coverage models demonstrated significant differences in total macular coverage required for improved diagnostic accuracy, with the largest macular area being relevant in POAG followed by DME and then AMD. These findings support our hypothesis that the extent of macular coverage by OCT imaging in the clinical setting, for any of the three major disorders, has a measurable impact on the functionality of artificial intelligence decision support. Translational Relevance We used machine learning techniques to improve OCT imaging standards for common retinal disease diagnoses.

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